AB0769 Treatment outcomes of patients with biological therapy during pregnancy and effect of pregnancy planning on treatment preferance of rheumatologists
Authors: Y. Erez, S. B. Kocaer, G. Can, M. Birlik, F. Onen, İ. Sari
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatic diseases occur mostly in adults at reproductive age. In addition to the impact of disease course on fetal and maternal health, safety concerns regarding the effects of biological drugs on the course of pregnancy have come to the fore with the introduction and widespread use of them. Unlike other biological treatments, all tumor necrosis factor (TNF) antagonists can be used during pregnancy. Objectives To investigate clinical features, treatment characteristics and pregnancy outcomes of patients with biological treatment and evaluate impact of planning pregnancy on treatment preferance. Methods The study was planned between January 2015 and December 2021. Patients who received biological treatment at conception were determined retrospectively. Demographycal data, clinical features, treatment characteristics and pregnancy outcomes were recorded. Results 15 patients (mean age 37.2±4) were included. Mean age at diagnosis was 25.6±5.4 and age at gestational was 33±3.9. Mean follow-up duration was 96±55 months. Median period of biological therapy was found 37 (1-156) months. Six (40%) patients were diagnosed with Axial Spondyloarthritis, 6 (40%) Psoriatic Arthritis, 1 (6.6%) Rheumatoid arthritis. While 12 (80%) patients had planned (wanted) pregnancies, 10 (66%) patients were evaluated as eligible for pregnancy in terms of rheumatological disease by rheumatologists. 13 (86.6%) patients were in remission/partial remission before pregnancy. 5 (33.3%) patients were using steroid and disease modifying anti-rheumatic drugs (DMARDs ) were stopped before conception. 10 (66.6%) patients were receiving certolizumab, 4 (26.7%) patients were receiving adalimumab. It was found that the treatment of the patient who received rituximab was interrupted due to the pregnancy planning. While certolizumab treatment continued in 6 (60%) patients during pregnancy, the treatment of patients receiving adalimumab was discontinued within first trimester. Activation of disease was occurred in 2 patients whose therapy interrupted. Biological treatment was restarted during pregnancy in 3 of 9 patients whose biological treatment was discontinued. No perinatal complication was developed except premature rupture of membranes in one patient. It was observed that all infants were healthy at birth, but baby of the mother who received certolizumab was diagnosed mental retardation in early childhood. Conclusion In this study, it was established that the majority of patients using TNF antagonist during pregnancy; 1-Having wanted/planned pregnancy, 2-Being in remission or low disease activity before pregnancy, 3-Not experiencing disease activation during pregnancy. In this study, it was concluded that having a pregnancy plan may be an important factor for rheumatologists to decide type of TNF antagonist, and physicians tend to prefer certolizumab in patients with pregnancy plan. Table 1. Baseline clinical and treatment characteristics Age, years 37.2±4 Age, at diagnosis 25.6±5.4 Age, at gestation 33±3.9 Follow-up duration, months 96±55 Biologic treatment duration, months 37 (1-156) Rheumatologic disease n (% ) -Spondyloarthritis 6 (40) -Psoriatic arthritis 6 (40) -Rheumatoid arthritis 1 (6.6) -Behcet disease 1 (6.6) -Systemic lupus eritematosus 1 (6.6) Biologic treatment n (% ) -Certolizumab* 10 (66.6) -Adalimumab* 4 (26.7) Discontinuation of treatment 9 (60) Restart 3 (33.3) Disease activity Remission/partial remission* 13 (86.6) Activation during pregnancy 3 (20) *At conception Disclosure of Interests None declared